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題 名 | CT Images of Blunt Renal Trauma: Correlating the Degree of Hematuria, CT Classification, Treatment and Outcome=腎臟鈍傷之電腦斷層影像:比較血尿程度、電腦斷層之分類、治療與預後 |
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作 者 | 阮春榮; 劉昌憲; 薛俊仁; 范洪春; 于大雄; 吳清俊; 陳震宇; 江龍輝; |
書刊名 | 中華放射線醫學雜誌 |
卷 期 | 27:4 2002.08[民91.08] |
頁 次 | 頁157-163 |
分類號 | 416.14 |
關鍵詞 | 腎臟鈍傷; 電腦斷層攝影; 血尿; Blunt renal trauma; Computed tomography; CT; Hematuria; |
語 文 | 英文(English) |
中文摘要 | 本研究的目的是針對腎臟鈍傷病患之血尿情況、電腦斷層攝影之發現、處置與預後加以分析。本研究收集在過去五年的期間的90個因腹部鈍傷而有腰痛及血尿之症狀的病患,所有的病患皆經電腦斷層攝影確定為腎臟鈍傷。根據電腦斷層攝影的特徵,我們進一步將所有的病患分為4組(第一組為表淺的腎臟皮質撕裂傷或腎臟外圍血腫;第二組為深層的腎臟皮質髓質撕裂傷;第三組為粉碎性的腎臟皮質髓質傷或是主要的腎臟血管傷害;第四組為腎盂或是腎盂與輸尿管交界處之傷害)。所有的病例及手術紀錄均加以詳細的回顧。本研究共包括72位男性,18位女性,男女比例為4:1。病患的年紀從一歲到八十三歲,平均為二十九點七歲。有六十三人為第一級腎臟傷害,九人為第二級,十五人為第三級,三人為第四級。在治療方面,有七十八人僅需要保守性療法,三人接受腎臟縫合手術,六人接受腎臟切除手術,有一人因為合併有十二指腸破裂導致腎臟周圍膿瘍而需接受經皮引流術之治療。在預後方面,九十個病患中有兩個死亡病例(2.2%)。其中一人因為腎動脈出血而另一人因為骨盆及股骨多處骨折導致低血容性之休克而死亡。雖然在絕大多數病患身上輕微血尿(microscopic hematuria)代表著較輕微的腎臟傷害,嚴重的腎臟傷害像腎動脈的傷害也可以僅表現出輕微血尿,且容易被超音波所忽略,故仍需要電腦斷層攝影檢查。對比劑顯影之電腦斷層攝影能夠準確的顯現出腎臟鈍傷的嚴重性。配合病患血液動力學的情況,電腦斷層攝影能夠幫助外科醫師決定適當治療的方式。除了兩位因大量出血而死亡的病例外,絕大多數腎臟鈍傷病患的預後良好。 |
英文摘要 | The aim of this study is to correlate the degree of hematuria, grade in CT classification, treatment and outcome in patients with blunt renal trauma. Ninety patients (72 men and 18 women) with blunt renal trauma presenting flank pain and hema-turia received contrast-enhanced CT study within 12 hours after trauma. According to the CT appear-ance, blunt renal trauma was further classified into four grades. Results were compared to the surgical findings and clinical follow-up. There were 63 cases with grade I renal lesions, nine grade II, 15 grade III and three grade IV. Seventy-eight of 90 cases (86.7%) required conserv-ative treatment only, three (3.3%) received renor-rhaphy and six (6.7%) underwent nephrectomy. One (1.1%) with perirenal hematoma complicated by perirenal abscess required percutaneous drainage. One (1.1%) with a grade I renal lesion expired due to hypovolemic shock after multiple fractures of the pelvis and the femur. Another one (1.1%) with a grade III lesion expired due to active renal arterial hemorrhage. The motality rate in patients with blunt renal trauma was 2.2% (2/90). Two cases of major vascular pedicle injury presented microscopic hematuria only. Althrough the presence of microscopic hematuria may suggest mild blunt renal trauma in most cases, patients with vascular pedical injury may present with microscopic hematuria only. Contrast-enhanced CT is capable of demonstrating the severity of blunt renal trauma. The CT findings associated with clinical evaluation on patient’s hemodynamic status may provide important infor-mation for surgical treatment planning. In our study, the overall prognosis of blunt renal trauma is generally good. |